Childhood Obesity in London

Professor Paul Plant Deputy Director Health Improvement Public Health England - London Almost one in four children in Reception and more than one in three children in Year 6 are overweight or obese

**In Reception (4 to 5 years):** London 23%, England 22.2% overweight or obese

**In Year 6 (10 to 11 years):** London 37.4%, England 33.3% overweight or obese London has a high rate of child obesity compared to other global cities.

In contrast to London, New York City has seen a decline in child obesity over time.

In Tokyo, obesity is classed as BMI ≥ 25 instead of 30, therefore separate overweight/obesity measures are difficult to obtain: % children with BMI ≥ 30 was not available in Tokyo.

SOURCE: Obesity in K–8 Students — New York City, 2006–07 to 2010–11 School Years. MMWR Morb Mortal Weekly Rep. 2011 Dec 16;60(49);1673-1678; LHC global cities analysis, 2014 Why are our children getting fatter?

• Everyone has a theory! The Foresight Report maps the whole picture

• Determinants multi-factorial & operate in complex ‘interactive’ ways

• Behaviours are learnt and habits formed early

• We make choices but not in circumstances of our own making

• Great increase in the prompts and opportunities to consume low price calories (eg fast food)

• Demise of older eating habits (eg role of food in the family) and start of new ones

• Physical activity patterns are changing

• Obesity is an inequalities issue Why are our children getting fatter?

......A simplified version What does the evidence tell us?

- There is no simple or single solution: need whole system approach
- Social marketing can work if based on consumer insight and power of different media

148 m cubes of sugar taken out of diet (2015) 104 m additional minutes of activity reported (49 minutes per family) (2014)

- ‘Upstream’ interventions have more impact but are more difficult to agree

- Intervening early in life more acceptable and more cost effective

- Personal support services may be too costly in future? What are boroughs doing?

- Some adopting a system leadership approach, multiple upstream interventions (eg Three boroughs, Tower Hamlets, six east London boroughs)

- London Food Board and School Food Trust sponsoring whole system approaches (Food Flagship Boroughs: Lambeth & Croydon)

- Many supporting school based action, with GLA Healthy Schools programme active in over 1000 schools

- Opposite end of spectrum some stuck at the personal service intervention ‘end’ only providing face to face support (eg weight management) School and wider food environment

- 40% of children eat school meals - in some areas, school meals make up just 15% of meals consumed by school age children

- Fast food outlets need targeted action as they are an important and popular food source for children and young people (38% of Newham teenagers eat fast food once a week and 12% eat fast food every day)

- Significant proportion of students’ fat, salt and sugar intake comes from these foods, with a standard meal containing 58% RDA kcal, 51% RDA saturated fat and 52% RDA salt

- Some shops use ‘student offers’ specifically to target school children

- Interesting work by City University looking at fast food and what young people think in Haringey. Case studies in London have demonstrated the popularity and feasibility of healthy alternatives

**Box Chicken pilot, Newham**

- We Are What We Do demonstrated the viability of a healthy, popular and financially sustainable alternative to existing fast food outlets through the Box Chicken pilot in Newham.
- Mobile catering unit set up from 12-5pm Monday to Friday for a month.
- Four recipes developed, all in line with PHE healthy eating guidelines.
- Target audience: students at three local schools and members of the local community. Many students also took boxes home for their parents.
- Hot, cheap and quick one pot meals served.
- During the one month pilot with one van, Box Chicken made £970 profit, excluding the caterer salary. 50% more meal sales would be needed to break even. Box Chicken would be likely to reach profitability with a longer trading period and economies of scale. The council waived trading fees\* for operation.

* Newham street trading licence £25 application + £24/week

SOURCE: Box Chicken final report Health democracy in action

• Health improvement activities best directed and lead by leaders close to the communities they serve - you have legitimacy and understanding to take action on their behalf.

• A role for national and regional organisations in support and to take action that can only be done at that level (eg reformulation of sugar in drinks).

• Public Health England: • Provides evidence and health intelligence (eg recent sugar in diet recommendations) • Leads national social marketing activities • Contributes to pan-London partnerships Better Health for London

Ambition

- Give every child the best start in life, taking a family based approach
- Work with schools, making London schools the healthiest in the country
- Reduce the proportion of sugar in children’s diet by 50%
- Develop healthy urban environments for children to grow and develop
- Work together across London with new partners to find innovative solutions We will make collective progress if we:

**Focus on children** – give every child the best start in life and make London a great way to raise a family that is active and eats healthily.

**Supporting families** – to meet this aspiration recognising the reality of bringing up children in different parts of the city.

**Uniting** - agreeing a common set of ambitions for the city – to focus our collective efforts and scarce resources, recognising that each agency will make local decisions.

**Supportive messaging** - supporting messages that are positive and consistent so wherever a family lives they are clear about what they can do for their children to ensure they have a healthy diet and are active.

**Doing things together** - a small number of things where action at a pan-London level makes the most sense Supporting local action

- London Prevention Board - childhood obesity a priority
- DPH for Lewisham leads for Directors of Public Health
  - Active London obesity leads network
  - New London obesity group inaugural meeting 8th October
- Work being commissioned where evidence weak (eg return on investment)
- Sector led improvement on obesity, led by London Association of Directors of Public Health
- Working with new partners eg London Sport, Jamie Oliver Foundation, planners, transport etc - building strategic alliances and relationships
- PHE have developed tools, data, evaluation guides, economic assessment aids etc to help local authorities plan obesity strategies: https://www.noo.org.uk/ What next?

• By working together we will have greater impact • Let’s be innovative together – if we always do what we’ve always done……….and learn collectively • We will be failing our children if we don’t find innovative solutions • London can lead the way in turning the tide on obesity and giving every child the best start in life